The Prepared Patient: Policy Solutions to Fix the Unaffordability Crisis
Healthcare in 2026 is breaking household budgets, and we know exactly why. Do we have the political will to fix this mess? Knowing where the high costs are coming from is one step to being a Prepared Patient.
The U.S. now spends over 5 trillion dollars a year on healthcare, more than 15,000 dollars per person, yet affordability keeps getting worse for patients. Premiums rise. Deductibles grow. Medical debt persists even for people who are insured. (CMS National Health Expenditure Data)
The core issue is structural, not behavioral. Patients are not “overusing” care. The system is built in a way that rewards high prices, complexity, and consolidation.
The biggest cost drivers are hospital and outpatient care. Hospital spending alone represents about one third of total healthcare spending, and commercial prices continue to rise faster than wages and inflation. Research from studies in JAMA Health Forum shows that higher prices, not better outcomes, explain much of the spending gap in consolidated markets.
Administrative complexity quietly consumes an enormous share of healthcare dollars. Billing, coding, prior authorization, and insurance friction account for an estimated 15 to 25 percent of total spending. Patients pay for this through higher premiums and cost sharing, not better care. Administration is one area in healthcare where technology solutions may help reduce administrative waste and lower costs.
Prescription drugs are not the largest spending category, but they are among the most visible pain points and are rising faster than for other expenditures. Specialty drugs and chronic disease therapies (including GLP-1s) are driving growth, and negotiated savings often do not reach patients at the pharmacy counter.
The human impact is already here. Over 1.5 million people have opted out of health insurance coverage in 2026. People delay or skip care due to cost. Employers shift costs to workers through higher deductibles and slower wage growth. Medical debt continues to affect household financial stability.
If nothing changes, affordability will keep deteriorating even as spending rises. The Commonwealth Fund continues to rank the U.S. last among peer nations on affordability, despite far higher per capita spending.
What would actually help is not complicated, but it requires political and institutional will. Policy solutions that would meaningfully improve affordability include:
Site neutral payments so the same service costs the same regardless of setting
Stronger antitrust enforcement to reduce price inflation driven by consolidation
Reform PBM incentives so negotiated drug rebates and discounts flow directly to patients at the pharmacy counter, rather than rewarding higher list prices and opaque spread pricing
Caps on out of pocket costs for essential chronic medications
Limits on anti-competitive contracting practices that block real price competition
Standardized and simplified prior authorization and claims processes
Drug price negotiation paired with reforms that pass savings directly to patients
Greater investment in primary care and chronic disease management to prevent expensive downstream care
Healthcare is unaffordable because we as a nation tolerate high prices, high administrative waste, and weak competition in the largest parts of the system. Until reforms focus on those drivers, affordability will keep getting worse no matter how much we spend. Next up, next week, what you can do as an individual to survive this mess.
The Prepared Patient: Your Guide to Surviving the Healthcare System is available for pre-sale from Johns Hopkins University Press.